Mica Jill Ingram, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

51740 Issued in TX

Practice address

400 W Ih 635 Fwy Ste 360
Irving, TX 75063-3764

Phone

(972) 402-8404

Fax

(972) 695-8796

NPI assigned

Sep 20, 2007

Last updated

Jul 9, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Irving Coppell Ear, Nose and ThroatGroup PAC ID 0042229726, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Irving Coppell Ear, Nose & Throat

  • Otolaryngology Physician
  • Irving, TX
  • NPI 1144412990
  Medicare reassignment Care Compare group NPD
• Blue Ribbon Dermatology PLLC

  • Dermatology Physician
  • Allen, TX
  • NPI 1962219535
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1720274061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W IH 635 FWY STE 360",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750633764",
            "telephone_number": "972-402-8404",
            "fax_number": "972-695-8796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W IH 635 FWY STE 360",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750633764",
            "telephone_number": "972-402-8404",
            "fax_number": "972-695-8796"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 State Highway 121",
            "address_2": "Suite A250",
            "address_purpose": "LOCATION",
            "city": "Lewisville",
            "state": "TX",
            "postal_code": "75067",
            "country_code": "US",
            "telephone_number": "214-491-2359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "MICA",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-20",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IL",
            "license": "147001032",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TX",
            "license": "51740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211151001",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imedic Transportation LLC
• P Brad Imler, LCSW, PH.D.
• Impact Psychological Assessments, PLLC
• Imperio Chiropractic Clinic
• In His Image Counseling Center, PLLC
• Goldie Lynn Ingstad, L.M.T
• Injury Assistance Centers, Inc.
• Injury Medical Solutions PLLC
• Inmotion Center, PA
• Nancy I. Innis, LPC-S

• Audiologist in Irving, TX
• Providers in Irving, TX by specialty
• Audiologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.